| NPI | 1215063581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-0-11885) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019011885) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2013-02-01 |